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Welcome

Committees play an important role in the municipal decision-making process and provide an opportunity for public engagement and participation.

First Name

Last Name

Phone Number

Street Address

City/Town

Postal Code

E-mail

Please identify community or other organizations with which you are currently affiliated:

Describe any specific knowledge or experience you have related to the committee:

Describe your prior experience you have serving on a committee or board:

If appointed, are there any issues that you feel should be considered by the committee(s) you have selected?

If appointed, are there any issues that you feel should be considered by the committee(s) you have selected?

Yes

No

The personal information on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, Chapter 25, as amended and is used solely for the purposes related to the appointment of citizens at large to Council Committees. If you are appointed to a Council Committee, your name may be viewed by the public. If you have any questions about the use of this information, please contact the Clerk's Office at 200 Broadway Street, 2nd Floor, Tillsonburg, ON N4G 5A7, by phone at (519) 688-3009 ext. 3221 or by email at clerks@tillsonburg.ca.